We carried out an announced comprehensive inspection on 16 June 2016 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations.

Background

Sheen Dental is located in the London Borough of Richmond-upon-Thames. The premises are situated in a converted, residential building in a high-street location. There are five treatment rooms, a decontamination room, an X-ray room, administrative offices, reception and waiting areas and patient toilets. These are distributed across the ground and first floors of the building.

The practice provides NHS and private services to adults and children. The practice offers a range of dental services including routine examinations and treatment, veneers and crowns and bridges. The practice also offers specialist services such as implants, orthodontics and conscious sedation.

The staff structure of the practice consists of a principal dentist, three associate dentists, three hygienists, three dental nurses, a practice manager and two receptionists. There is also a specialist orthodontist and a visiting oral surgeon.

The practice opening hours are Monday to Friday from 8.00am to 5.00pm. The practice is also open from 9.00am to 1.00pm on Saturdays.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

The inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.

Fifty-five people provided feedback about the service. Patients were positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the dental staff.

Our key findings were:

• Patients’ needs were assessed and care was planned in line with current guidance such as from the National Institute for Health and Care Excellence (NICE).

• There were effective systems in place to reduce and minimise the risk and spread of infection.
• The practice had safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• Staff reported incidents and kept records of these which the practice used for shared learning.
• There were effective arrangements in place for managing medical emergencies.
• Equipment, such as the air compressor, fire extinguishers, and X-ray equipment had all been checked for effectiveness and had been regularly serviced. However, systems for managing stock and security of prescription pads could be improved.
• Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team.
• The practice ensured staff maintained the necessary skills and competence to support the needs of patients. However, improvements could be made to ensure a formal staff appraisal process was put in place.
• The practice had clear procedures for managing comments, concerns or complaints.
• The provider had a clear vision for the practice and staff told us they were well supported by the staff team.
• There were arrangements for identifying, recording and managing risks through the use of risk assessments and audit processes. However, we identified some areas where improvements were required.

There were areas where the provider could make improvements and should:

• Review the security of prescription pads in the practice and ensure there are systems in place to monitor and track their use.
• Review stocks of medicines and equipment and the system for identifying and disposing of out-of-date stock.
• Review the practice’s responsibilities as regards to the Control of Substances Hazardous to Health (COSHH) Regulations 2002; ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.
• Review the practice’s sharps procedures giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review recruitment procedures to ensure accurate, complete and detailed records are maintained for all staff.
• Review the training, learning and development needs of individual staff members at appropriate intervals and ensure an effective process is established for the on-going assessment, supervision and appraisal of all staff.
• Review systems for seeking and acting on feedback from patients or staff for the purposes of continually evaluating and improving the service.
• Review its audit protocols to ensure audits of various aspects of the service are undertaken at regular intervals and where applicable learning points are documented  and shared with all relevant staff.

People who are registered with the practice told us they were satisfied with the service and treatment they received and way it was provided. People said "I've been coming ten years and am very satisfied ". "My wife and children also use this dentist". "Always happy to come here".

People told us they had the consultation procedure, available treatments and costs clearly explained to them. This included any risks attached to the treatments. They said they were treated with dignity and respect by staff and felt safe using the clinic.

They did not comment on the practice safeguarding or infection control systems. They did tell us they thought the centre was kept clean, tidy and observed their right to privacy.